This application is part of a long-term effort to expand knowledge through research on the health consequences for children of the HIV/AIDS pandemic in Sub-Saharan Africa and to evaluate strategies to cope with these persisting consequences. The mental health impact on children of caregivers becoming ill and dying has been a relatively neglected area of research particularly in the developing world and stands in the face of the growing awareness that HIV affected children are themselves among the most at risk for acquiring HIV in their adolescent or adult years. This application builds on the multilevel and longitudinal design of the Project on Human Development in Chicago Neighborhoods (PHDCN), the service and advocacy of a community-based organization (KIWAKKUKI) and the research capacity of a highly respected medical institution in Northern Tanzania (KCMC). There are three primary goals of this research. The project begins with a neighborhood survey to determine demographic and structural characteristics, HIV stigma/discrimination, collective efficacy, and youth HIV risk behaviors in a representative sample of adult and youth residents of Moshi Urban District. A subset of these neighborhoods will be recruited into an experimental intervention designed to improve child mental health by intervening at both the household and neighborhood levels. This will be followed by a reassessment of the intervention and control neighborhoods to measure change in social processes. At the household level the intervention uses a nurse home visitation model to 1) promote the social support of primary caregivers of preschool and preadolescent children, 2) to improve their child rearing skills and 3) to improve the physical growth and mental health of their children. At the neighborhood level, the intervention adopts a child health promotion model to 1) improve social processes related to the collective socialization of children, 2) promote the physical and mental health of children, and 3) reduce stigma and discrimination towards persons with HIV/AIDS. In addition to assessing change in neighborhood processes, mental health outcomes for the primary caregivers and children will be measured. Through such comprehensive and intensive study of one urban district, the information acquired on principles and procedures should provide the opportunity to extend these interventions and this evaluation approach to other regions of Eastern and Southern Africa impacted by the HIV pandemic.